- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.00 / $3,000.00 / $10,546.00
| Facility | | $748.00 | $3,000.00 | $10,546.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.82 / $4,769.29 / $9,689.51
| Facility | | $2,642.82 | $4,769.29 | $9,689.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.45 / $2,638.80 / $2,638.80
| Facility | | $226.45 | $2,638.80 | $2,638.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.10 / $2,376.10 / $2,376.10
| Facility | | $2,376.10 | $2,376.10 | $2,376.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $2,081.44
| Facility | | $55.00 | $55.00 | $2,081.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.38 / $841.30 / $1,881.92
| Facility | | $256.38 | $841.30 | $1,881.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.38 / $941.77 / $2,417.36
| Facility | | $256.38 | $941.77 | $2,417.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |